| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
985 |
339 |
$142K |
| D0210 |
Intraoral - complete series of radiographic images |
846 |
841 |
$65K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
273 |
147 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
708 |
143 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
425 |
401 |
$8K |
| D1110 |
Prophylaxis - adult |
251 |
249 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
29 |
$4K |
| D4355 |
|
60 |
59 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
90 |
54 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
861 |
855 |
$1K |
| D0330 |
Panoramic radiographic image |
17 |
17 |
$414.01 |
| D0220 |
Intraoral - periapical first radiographic image |
299 |
282 |
$9.22 |
| D0230 |
Intraoral - periapical each additional radiographic image |
151 |
83 |
$0.00 |